This document discusses the assessment and treatment of injuries to the liver. It describes the anatomy and blood supply of the liver. Grading scales are used to classify the severity of hepatic injuries from minor lacerations to complete avulsion. For complex injuries, temporary control of bleeding through manual compression, perihepatic packing, or clamping the hepatic pedicle (Pringle maneuver) can provide time for resuscitation before definitive treatment.
This document discusses liver trauma, including:
- The liver is prone to blunt injury due to its friable parenchyma and fixed position. Right lobe injuries are more common.
- Mechanisms of injury include blunt trauma from the ribs/spine, high-velocity bullets, stab wounds, and medical procedures.
- Associated injuries occur in 45% of blunt trauma cases and 33% with rib fractures.
- Injuries range from subcapsular hematomas to lacerations to devascularization. Severe injuries take 9-15 months to heal.
- Clinical signs include blood loss, abdominal tenderness, and delayed abscess. Imaging like CT scan is used to diagnose and monitor healing.
El documento resume la historia, epidemiología, clasificación, diagnóstico y manejo del trauma hepático. Describe las lesiones hepáticas desde lesiones leves (Grado I-II) hasta graves (Grado IV-V), y los enfoques de manejo que incluyen el manejo conservador, cirugía y técnicas quirúrgicas como empacado hepático, resecciones hepáticas y bypass venoso. Resalta factores predictivos de malos resultados como hipotensión, necesidad de transfusión y lesiones de alto grado.
This document discusses liver trauma resulting from blunt and penetrating injuries. It describes two case studies, one involving a car accident and the other a stabbing. The car accident patient had liver lacerations that were managed surgically, while the stabbing victim had a liver wound and duodenal injury repaired during an emergency laparotomy. The document provides background on liver anatomy and the types and grading of liver injuries. Treatment approaches include conservative management for stable patients and surgery for unstable patients or those with additional injuries requiring operation.
El hígado es el segundo órgano más comúnmente lesionado en traumas cerrados y abiertos. Los traumas hepáticos se clasifican dependiendo de la gravedad de la lesión en una escala de I a VI. Las lesiones menores (grado I-II) a menudo se tratan de forma no quirúrgica con observación, mientras que las lesiones mayores (grado III-VI) generalmente requieren cirugía para controlar la hemorragia. Las complicaciones posoperatorias comunes incluyen sangrado, abscesos e infecciones.
El hígado es el segundo órgano más comúnmente lesionado en traumas cerrados y abiertos. Las lesiones hepáticas pueden clasificarse en 5 grados dependiendo de la profundidad y extensión de la lesión, y las lesiones de grado III o superior tienen altas tasas de mortalidad. El diagnóstico incluye pruebas de imagen como tomografía computarizada y ultrasonido, mientras que el tratamiento depende de la gravedad de la lesión y la estabilidad del paciente, variando desde el manejo médico hasta la cirugía
1) The document discusses the diagnosis and treatment of intra-abdominal injuries, including the external anatomy of the abdomen, classification of injuries as blunt, penetrating, or iatrogenic, signs and symptoms of potential abdominal injury, and priorities for diagnosis and management.
2) Key diagnostic tests discussed are physical exam, plain films, FAST ultrasound, CT scan, diagnostic peritoneal lavage, and exploratory laparotomy. Indications, advantages, limitations, and sensitivities of each test are provided.
3) Treatment priorities and approaches are outlined, including resuscitation, damage control resuscitation, identifying the source of bleeding, and surgical procedures for exploratory laparotomy and repair of specific organ injuries
The document outlines the evaluation and management of liver trauma in children. The liver is prone to blunt injury due to its friable parenchyma and fixed position. Most liver injuries in children are caused by deceleration or crush injuries from blunt trauma. Hemodynamic stability guides management, with conservative treatment sufficient for most grades I-III injuries. Operative treatment is considered for grades IV-V or if the patient is unstable. The mortality rate for liver trauma has significantly decreased over the past century with advances in care.
The document describes a standardized classification system for grading the severity of liver injuries. The classification system ranges from Grade I to Grade VI injuries, with higher grades indicating more severe injuries involving deeper lacerations, larger hematomas, and greater parenchymal disruption or vascular injuries. CT imaging is useful for evaluating the extent of injuries and assigning a grade.
This document discusses liver trauma, including:
- The liver is prone to blunt injury due to its friable parenchyma and fixed position. Right lobe injuries are more common.
- Mechanisms of injury include blunt trauma from the ribs/spine, high-velocity bullets, stab wounds, and medical procedures.
- Associated injuries occur in 45% of blunt trauma cases and 33% with rib fractures.
- Injuries range from subcapsular hematomas to lacerations to devascularization. Severe injuries take 9-15 months to heal.
- Clinical signs include blood loss, abdominal tenderness, and delayed abscess. Imaging like CT scan is used to diagnose and monitor healing.
El documento resume la historia, epidemiología, clasificación, diagnóstico y manejo del trauma hepático. Describe las lesiones hepáticas desde lesiones leves (Grado I-II) hasta graves (Grado IV-V), y los enfoques de manejo que incluyen el manejo conservador, cirugía y técnicas quirúrgicas como empacado hepático, resecciones hepáticas y bypass venoso. Resalta factores predictivos de malos resultados como hipotensión, necesidad de transfusión y lesiones de alto grado.
This document discusses liver trauma resulting from blunt and penetrating injuries. It describes two case studies, one involving a car accident and the other a stabbing. The car accident patient had liver lacerations that were managed surgically, while the stabbing victim had a liver wound and duodenal injury repaired during an emergency laparotomy. The document provides background on liver anatomy and the types and grading of liver injuries. Treatment approaches include conservative management for stable patients and surgery for unstable patients or those with additional injuries requiring operation.
El hígado es el segundo órgano más comúnmente lesionado en traumas cerrados y abiertos. Los traumas hepáticos se clasifican dependiendo de la gravedad de la lesión en una escala de I a VI. Las lesiones menores (grado I-II) a menudo se tratan de forma no quirúrgica con observación, mientras que las lesiones mayores (grado III-VI) generalmente requieren cirugía para controlar la hemorragia. Las complicaciones posoperatorias comunes incluyen sangrado, abscesos e infecciones.
El hígado es el segundo órgano más comúnmente lesionado en traumas cerrados y abiertos. Las lesiones hepáticas pueden clasificarse en 5 grados dependiendo de la profundidad y extensión de la lesión, y las lesiones de grado III o superior tienen altas tasas de mortalidad. El diagnóstico incluye pruebas de imagen como tomografía computarizada y ultrasonido, mientras que el tratamiento depende de la gravedad de la lesión y la estabilidad del paciente, variando desde el manejo médico hasta la cirugía
1) The document discusses the diagnosis and treatment of intra-abdominal injuries, including the external anatomy of the abdomen, classification of injuries as blunt, penetrating, or iatrogenic, signs and symptoms of potential abdominal injury, and priorities for diagnosis and management.
2) Key diagnostic tests discussed are physical exam, plain films, FAST ultrasound, CT scan, diagnostic peritoneal lavage, and exploratory laparotomy. Indications, advantages, limitations, and sensitivities of each test are provided.
3) Treatment priorities and approaches are outlined, including resuscitation, damage control resuscitation, identifying the source of bleeding, and surgical procedures for exploratory laparotomy and repair of specific organ injuries
The document outlines the evaluation and management of liver trauma in children. The liver is prone to blunt injury due to its friable parenchyma and fixed position. Most liver injuries in children are caused by deceleration or crush injuries from blunt trauma. Hemodynamic stability guides management, with conservative treatment sufficient for most grades I-III injuries. Operative treatment is considered for grades IV-V or if the patient is unstable. The mortality rate for liver trauma has significantly decreased over the past century with advances in care.
The document describes a standardized classification system for grading the severity of liver injuries. The classification system ranges from Grade I to Grade VI injuries, with higher grades indicating more severe injuries involving deeper lacerations, larger hematomas, and greater parenchymal disruption or vascular injuries. CT imaging is useful for evaluating the extent of injuries and assigning a grade.
The liver is prone to injury due to its fixed position in the abdomen. Liver trauma can be caused by blunt or penetrating injuries from accidents or assaults. Blunt trauma may cause lacerations or hematomas while penetrating injuries pose risks of bleeding. Symptoms include right upper quadrant pain and tenderness. CT scans can diagnose lacerations while peritoneal lavage detects internal bleeding. Large lacerations require surgery while some small lacerations can be monitored. Complications include bleeding, infection, and organ dysfunction. Nursing focuses on pain management, monitoring for worsening conditions, and addressing anxiety through education and medication.
Este documento resume la patofisiología, clasificación, tratamiento y complicaciones del trauma hepático. El hígado es el segundo órgano más lesionado después de un traumatismo abdominal y puede sufrir hematomas, desgarros o laceraciones. Existen 5 grados de lesión hepática. Para detener el sangrado se usan técnicas como sutura, hemostasia, taponamiento o resección. El tratamiento depende de la gravedad de la lesión y la estabilidad del paciente. Las complicaciones incluyen hemorragia,
Liver Anatomy (basics), types of liver injuries, ingury scoring scale for liver, CT pictures of different grades, non-operative and operative managment of liver trauma.
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Made by Surgical Club Armata Manus (armata-manus.com)
This document presents a case of traumatic liver injury in a 17-year old male patient who was in a motorcycle accident. He presented with abdominal pain and vomiting. Imaging showed a liver laceration and bleeding in the abdomen. He underwent an exploratory laparotomy where a left lobe liver laceration and diaphragm perforation were found and repaired. He recovered well after surgery with drain removal after one week and was discharged. Traumatic liver injuries can range from minor injuries treated non-operatively to severe injuries requiring surgery like lobectomy or packing to control bleeding. Both non-operative and surgical management were discussed.
This document summarizes blunt abdominal trauma in children. It covers common causes including motor vehicle crashes and falls. Mortality varies from less than 20% for isolated injuries to 50% for major vessel injuries. The anatomy of children's abdomens makes them more susceptible to injury. Evaluation involves history, physical exam assessing signs of injury, and diagnostic testing including lab work, ultrasound, CT scans, and possible laparotomy. Common injuries discussed are spleen lacerations, liver lacerations, bowel perforations, and injuries from seat belts. Guidelines are provided for treatment and length of stay based on injury grade.
1) Liver trauma is the second most common organ injured in blunt abdominal trauma and the most common injured in penetrating trauma, occurring in 1-8% of patients with multiple blunt trauma.
2) The liver is susceptible to injury due to its size, friable parenchyma, thin capsule, and fixed position near the ribs and spine.
3) Liver injuries are classified based on the mechanism of injury, type and degree of damage, localization within liver lobes/segments, and whether associated vessels or bile ducts are damaged. Grades I-II are minor injuries while Grades III-V require surgical intervention and Grade VI is incompatible with survival.
Este documento describe la anatomía, clasificación, diagnóstico y tratamiento del trauma hepático. El hígado puede sufrir lesiones por traumas cerrados o penetrantes. El tratamiento depende de la gravedad de la lesión y busca controlar la hemorragia y prevenir infecciones. Las opciones incluyen manejo quirúrgico, como suturas, empaquetamiento o hepatectomía, y no quirúrgico, como arteriografía o balones de taponamiento. Las complicaciones potenciales son sangrado posoperatorio, abs
The liver is the second most commonly injured organ in blunt abdominal trauma and the most commonly injured in penetrating abdominal trauma. Non-operative management of liver injuries is now the standard of care for hemodynamically stable patients and has a success rate of over 85%, even for high-grade injuries. Failure of non-operative management is usually due to other intra-abdominal injuries rather than the liver injury itself. Operative intervention is indicated for hemodynamically unstable patients or those who fail non-operative management.
El documento describe el trauma de los grandes vasos abdominales. Resume la anatomía vascular abdominal relevante, las causas comunes de lesión, el diagnóstico mediante imágenes y el enfoque quirúrgico para reparar o reconstruir vasos dañados como la aorta, la vena cava y las arterias renales y mesentérica superior. El pronóstico depende de la gravedad de la lesión vascular y la rapidez del tratamiento quirúrgico para controlar la hemorragia.
Este documento presenta los resultados de un estudio retrospectivo sobre la sensibilidad y especificidad del ultrasonido FAST (focused assessment with sonography for trauma) para detectar líquido libre en pacientes con trauma abdominal. El estudio analizó 405 ultrasonidos FAST realizados entre 2004 y 2005, encontrando una sensibilidad del 100% y una especificidad del 97.78%. Diez casos clínicos ilustran hallazgos positivos en ultrasonido FAST confirmados posteriormente por tomografía computarizada.
This document discusses imaging for abdominal trauma. It begins by outlining the mechanisms and classifications of abdominal injury. FAST ultrasound is described as a rapid way to detect free fluid. CT is outlined as the preferred imaging method for evaluation of abdominal trauma. Specific injuries to organs like the spleen, liver, pancreas, and kidneys are then reviewed. Features of each injury on CT are provided along with grading scales. Management considerations for different injuries are also mentioned.
This document discusses abdominal trauma, including the anatomy of the abdomen, common mechanisms of injury like motor vehicle accidents and penetrating wounds, and the pathophysiology of blunt versus penetrating trauma. The most commonly injured organs from blunt trauma are the spleen, liver, and small bowel due to shearing and compression forces that can tear or rupture these solid organs.
Este documento describe las bases físicas del ultrasonido médico, incluyendo la frecuencia de los transductores, el efecto piezoeléctrico, la impedancia acústica y cómo afecta la profundidad de penetración. También explica conceptos como la ganancia, la zona focal, el campo de visión y cómo optimizar la imagen ecográfica. Finalmente, analiza posibles artefactos como sombras acústicas, imágenes especulares y reverberación.
This document discusses imaging in abdominal trauma. It begins by outlining the mechanisms and types of abdominal injuries from blunt and penetrating trauma. It then describes the FAST (Focused Assessment with Sonography for Trauma) exam and its role in the initial assessment of hemodynamically unstable patients. For stable patients, CT is typically used to further evaluate injuries suggested on clinical exam or FAST. The document outlines key CT findings for various intra-abdominal injuries and hemorrhage.
1) The document discusses the anatomy and surgical techniques of hepatic resection. It describes the segmentation of the liver and importance of understanding the vascular supply.
2) Preoperative imaging such as CT and MRI are important to evaluate lesions and vascular structures. Triple-phase CT is recommended.
3) Careful preparation is needed prior to hepatic resection, including correction of anemia/coagulopathy and antibiotic prophylaxis. Low central venous pressure under anesthesia can help reduce bleeding during the procedure.
This document discusses adrenalectomy, including:
1) The surgical approaches to adrenalectomy have evolved with laparoscopic techniques now used for most cases.
2) The main indications for adrenalectomy are hypersecretory tumors or potentially malignant lesions.
3) Common adrenal tumors include aldosteronoma, cortisol-producing adenomas, pheochromocytomas, adrenocortical carcinoma, and incidentalomas. Biochemical testing and imaging help diagnose and localize the tumors.
This document discusses the anatomy and surgical procedure of splenectomy. It describes:
- The spleen's highly variable arterial blood supply, which can take bundled or distributed patterns. This variability impacts the difficulty of surgery.
- The splenic artery typically branches off the celiac axis but can originate from other nearby arteries in rare cases.
- Additional branches of the splenic artery before it enters the spleen, including short gastric and pancreatic arteries.
- A history of splenectomy beginning in the 16th century and its increasing use through the 20th century for trauma and hematologic disorders.
- The development of laparoscopic splenectomy in the early 1990s and ongoing refinement of minim
This document discusses the anatomy and surgical procedure of splenectomy. It describes:
- The spleen's highly variable arterial blood supply, which can take bundled or distributed patterns. This variability impacts the difficulty of surgery.
- The splenic artery typically branches off the celiac axis but can originate from other nearby arteries in rare cases.
- In addition to main branches, the splenic artery also forms transverse anastomoses with collateral vessels at 90 degree angles, complicating efforts to occlude branches.
- A brief history of splenectomy, from its first reported use in the 16th century to modern adoption of laparoscopic techniques. Splenectomy became more common with automobile use and
The document discusses the anatomy and imaging of the liver. It provides details on:
1) The liver's dual blood supply and Couinaud classification which divides it into 8 functionally independent segments based on vascular inflow, outflow, and biliary drainage.
2) Imaging modalities like ultrasound, CT, and MRI which are used to evaluate the liver and characterize lesions using contrast enhancement in arterial and portal venous phases.
3) Developmental anomalies and anatomic variants of the liver that are important to recognize as incidental findings.
The document summarizes Couinaud's classification of liver anatomy and segmentation. It divides the liver into eight functionally independent segments based on vascular inflow, outflow, and biliary drainage. Each segment has its own branch of the portal vein, hepatic artery, and bile duct in the center, and vascular outflow through the hepatic veins in the periphery. The three major hepatic veins and portal vein fissures define the segments and lobes.
Acs0522 procedures for benign and malignant biliary tract disease-2005medbookonline
This document discusses procedures for benign and malignant biliary tract diseases. It provides guidance on preoperative evaluation and management of biliary obstruction. Specific considerations are given to infection, renal dysfunction, impaired immunity, malnutrition, and coagulation issues. The document outlines operative planning details such as patient positioning, exposure techniques, and guidelines for biliary anastomoses including suture placement and techniques for difficult access situations.
The liver is prone to injury due to its fixed position in the abdomen. Liver trauma can be caused by blunt or penetrating injuries from accidents or assaults. Blunt trauma may cause lacerations or hematomas while penetrating injuries pose risks of bleeding. Symptoms include right upper quadrant pain and tenderness. CT scans can diagnose lacerations while peritoneal lavage detects internal bleeding. Large lacerations require surgery while some small lacerations can be monitored. Complications include bleeding, infection, and organ dysfunction. Nursing focuses on pain management, monitoring for worsening conditions, and addressing anxiety through education and medication.
Este documento resume la patofisiología, clasificación, tratamiento y complicaciones del trauma hepático. El hígado es el segundo órgano más lesionado después de un traumatismo abdominal y puede sufrir hematomas, desgarros o laceraciones. Existen 5 grados de lesión hepática. Para detener el sangrado se usan técnicas como sutura, hemostasia, taponamiento o resección. El tratamiento depende de la gravedad de la lesión y la estabilidad del paciente. Las complicaciones incluyen hemorragia,
Liver Anatomy (basics), types of liver injuries, ingury scoring scale for liver, CT pictures of different grades, non-operative and operative managment of liver trauma.
Download and share
Made by Surgical Club Armata Manus (armata-manus.com)
This document presents a case of traumatic liver injury in a 17-year old male patient who was in a motorcycle accident. He presented with abdominal pain and vomiting. Imaging showed a liver laceration and bleeding in the abdomen. He underwent an exploratory laparotomy where a left lobe liver laceration and diaphragm perforation were found and repaired. He recovered well after surgery with drain removal after one week and was discharged. Traumatic liver injuries can range from minor injuries treated non-operatively to severe injuries requiring surgery like lobectomy or packing to control bleeding. Both non-operative and surgical management were discussed.
This document summarizes blunt abdominal trauma in children. It covers common causes including motor vehicle crashes and falls. Mortality varies from less than 20% for isolated injuries to 50% for major vessel injuries. The anatomy of children's abdomens makes them more susceptible to injury. Evaluation involves history, physical exam assessing signs of injury, and diagnostic testing including lab work, ultrasound, CT scans, and possible laparotomy. Common injuries discussed are spleen lacerations, liver lacerations, bowel perforations, and injuries from seat belts. Guidelines are provided for treatment and length of stay based on injury grade.
1) Liver trauma is the second most common organ injured in blunt abdominal trauma and the most common injured in penetrating trauma, occurring in 1-8% of patients with multiple blunt trauma.
2) The liver is susceptible to injury due to its size, friable parenchyma, thin capsule, and fixed position near the ribs and spine.
3) Liver injuries are classified based on the mechanism of injury, type and degree of damage, localization within liver lobes/segments, and whether associated vessels or bile ducts are damaged. Grades I-II are minor injuries while Grades III-V require surgical intervention and Grade VI is incompatible with survival.
Este documento describe la anatomía, clasificación, diagnóstico y tratamiento del trauma hepático. El hígado puede sufrir lesiones por traumas cerrados o penetrantes. El tratamiento depende de la gravedad de la lesión y busca controlar la hemorragia y prevenir infecciones. Las opciones incluyen manejo quirúrgico, como suturas, empaquetamiento o hepatectomía, y no quirúrgico, como arteriografía o balones de taponamiento. Las complicaciones potenciales son sangrado posoperatorio, abs
The liver is the second most commonly injured organ in blunt abdominal trauma and the most commonly injured in penetrating abdominal trauma. Non-operative management of liver injuries is now the standard of care for hemodynamically stable patients and has a success rate of over 85%, even for high-grade injuries. Failure of non-operative management is usually due to other intra-abdominal injuries rather than the liver injury itself. Operative intervention is indicated for hemodynamically unstable patients or those who fail non-operative management.
El documento describe el trauma de los grandes vasos abdominales. Resume la anatomía vascular abdominal relevante, las causas comunes de lesión, el diagnóstico mediante imágenes y el enfoque quirúrgico para reparar o reconstruir vasos dañados como la aorta, la vena cava y las arterias renales y mesentérica superior. El pronóstico depende de la gravedad de la lesión vascular y la rapidez del tratamiento quirúrgico para controlar la hemorragia.
Este documento presenta los resultados de un estudio retrospectivo sobre la sensibilidad y especificidad del ultrasonido FAST (focused assessment with sonography for trauma) para detectar líquido libre en pacientes con trauma abdominal. El estudio analizó 405 ultrasonidos FAST realizados entre 2004 y 2005, encontrando una sensibilidad del 100% y una especificidad del 97.78%. Diez casos clínicos ilustran hallazgos positivos en ultrasonido FAST confirmados posteriormente por tomografía computarizada.
This document discusses imaging for abdominal trauma. It begins by outlining the mechanisms and classifications of abdominal injury. FAST ultrasound is described as a rapid way to detect free fluid. CT is outlined as the preferred imaging method for evaluation of abdominal trauma. Specific injuries to organs like the spleen, liver, pancreas, and kidneys are then reviewed. Features of each injury on CT are provided along with grading scales. Management considerations for different injuries are also mentioned.
This document discusses abdominal trauma, including the anatomy of the abdomen, common mechanisms of injury like motor vehicle accidents and penetrating wounds, and the pathophysiology of blunt versus penetrating trauma. The most commonly injured organs from blunt trauma are the spleen, liver, and small bowel due to shearing and compression forces that can tear or rupture these solid organs.
Este documento describe las bases físicas del ultrasonido médico, incluyendo la frecuencia de los transductores, el efecto piezoeléctrico, la impedancia acústica y cómo afecta la profundidad de penetración. También explica conceptos como la ganancia, la zona focal, el campo de visión y cómo optimizar la imagen ecográfica. Finalmente, analiza posibles artefactos como sombras acústicas, imágenes especulares y reverberación.
This document discusses imaging in abdominal trauma. It begins by outlining the mechanisms and types of abdominal injuries from blunt and penetrating trauma. It then describes the FAST (Focused Assessment with Sonography for Trauma) exam and its role in the initial assessment of hemodynamically unstable patients. For stable patients, CT is typically used to further evaluate injuries suggested on clinical exam or FAST. The document outlines key CT findings for various intra-abdominal injuries and hemorrhage.
1) The document discusses the anatomy and surgical techniques of hepatic resection. It describes the segmentation of the liver and importance of understanding the vascular supply.
2) Preoperative imaging such as CT and MRI are important to evaluate lesions and vascular structures. Triple-phase CT is recommended.
3) Careful preparation is needed prior to hepatic resection, including correction of anemia/coagulopathy and antibiotic prophylaxis. Low central venous pressure under anesthesia can help reduce bleeding during the procedure.
This document discusses adrenalectomy, including:
1) The surgical approaches to adrenalectomy have evolved with laparoscopic techniques now used for most cases.
2) The main indications for adrenalectomy are hypersecretory tumors or potentially malignant lesions.
3) Common adrenal tumors include aldosteronoma, cortisol-producing adenomas, pheochromocytomas, adrenocortical carcinoma, and incidentalomas. Biochemical testing and imaging help diagnose and localize the tumors.
This document discusses the anatomy and surgical procedure of splenectomy. It describes:
- The spleen's highly variable arterial blood supply, which can take bundled or distributed patterns. This variability impacts the difficulty of surgery.
- The splenic artery typically branches off the celiac axis but can originate from other nearby arteries in rare cases.
- Additional branches of the splenic artery before it enters the spleen, including short gastric and pancreatic arteries.
- A history of splenectomy beginning in the 16th century and its increasing use through the 20th century for trauma and hematologic disorders.
- The development of laparoscopic splenectomy in the early 1990s and ongoing refinement of minim
This document discusses the anatomy and surgical procedure of splenectomy. It describes:
- The spleen's highly variable arterial blood supply, which can take bundled or distributed patterns. This variability impacts the difficulty of surgery.
- The splenic artery typically branches off the celiac axis but can originate from other nearby arteries in rare cases.
- In addition to main branches, the splenic artery also forms transverse anastomoses with collateral vessels at 90 degree angles, complicating efforts to occlude branches.
- A brief history of splenectomy, from its first reported use in the 16th century to modern adoption of laparoscopic techniques. Splenectomy became more common with automobile use and
The document discusses the anatomy and imaging of the liver. It provides details on:
1) The liver's dual blood supply and Couinaud classification which divides it into 8 functionally independent segments based on vascular inflow, outflow, and biliary drainage.
2) Imaging modalities like ultrasound, CT, and MRI which are used to evaluate the liver and characterize lesions using contrast enhancement in arterial and portal venous phases.
3) Developmental anomalies and anatomic variants of the liver that are important to recognize as incidental findings.
The document summarizes Couinaud's classification of liver anatomy and segmentation. It divides the liver into eight functionally independent segments based on vascular inflow, outflow, and biliary drainage. Each segment has its own branch of the portal vein, hepatic artery, and bile duct in the center, and vascular outflow through the hepatic veins in the periphery. The three major hepatic veins and portal vein fissures define the segments and lobes.
Similar to Acs0707 Injuries To The Liver, Biliary Tract, Spleen, And Diaphragm (6)
Acs0522 procedures for benign and malignant biliary tract disease-2005medbookonline
This document discusses procedures for benign and malignant biliary tract diseases. It provides guidance on preoperative evaluation and management of biliary obstruction. Specific considerations are given to infection, renal dysfunction, impaired immunity, malnutrition, and coagulation issues. The document outlines operative planning details such as patient positioning, exposure techniques, and guidelines for biliary anastomoses including suture placement and techniques for difficult access situations.
Gastrostomy is commonly used as a temporary procedure to avoid discomfort from prolonged nasogastric suction after major abdominal surgery. It can also be used permanently when the esophagus is obstructed to nonresectable cancer. The Stamm gastrostomy is most common temporary procedure where a catheter is placed through the stomach wall and anchored to the skin. The Janeway gastrostomy is a permanent alternative where a flap of stomach is brought through the abdominal wall and attached to form a mucosal lined tube to prevent regurgitation. Postoperative care involves gradual advancement to oral intake as the stomach heals and functions return to normal.
This document describes the Billroth I gastric resection procedure, which involves removing part of the stomach and reattaching it to the duodenum. Key steps include transecting the stomach, attaching it to the duodenum using a circular stapler, and closing the gastrotomy site. The procedure aims to control peptic ulcers by combining hemigastrectomy with vagotomy while restoring normal gastrointestinal continuity. Postoperative care focuses on gradual advancement of oral intake and monitoring for complications.
This document describes the Billroth I procedure for gastroduodenostomy. It involves extensive mobilization of the stomach and duodenum to allow for an end-to-end anastomosis between the stomach and duodenum, restoring normal continuity of the gastrointestinal tract. The stomach is divided and sutured closed, then sutured to the duodenum in layers to create the gastroduodenal connection. Postoperative care focuses on gradual advancement of diet and monitoring for gastric retention to support healing and prevent complications.
Gastrostomy is commonly used as a temporary procedure to avoid discomfort from prolonged nasogastric suction after major abdominal surgery. It can also be used permanently when the esophagus is obstructed to nonresectable cancer. The Stamm gastrostomy is most common temporary procedure where a catheter is placed through the stomach wall and anchored to prevent leakage. The Janeway gastrostomy is a permanent alternative where a flap of stomach is brought through the abdominal wall and lined with mucosa to form a permanent opening, preventing regurgitation. Postoperative care involves gradual advancement to oral intake as the stomach and bowel recover function.
Gastrojejunostomy is a surgical procedure that connects the stomach directly to the jejunum. It is indicated for patients with duodenal ulcers complicated by pyloric obstruction or nonresectable stomach or pancreatic cancers causing obstruction. The procedure involves opening the stomach and jejunum, suturing them together to form a stoma, then closing in multiple layers. Postoperatively, gastric emptying is monitored and diet advanced gradually to ensure proper healing.
This document provides guidance on treating a perforated ulcer or subphrenic abscess. It describes:
1) Preparing patients preoperatively by administering IV fluids/antibiotics and gastric suction.
2) Closing perforations by suturing the ulcer and reinforcing it with omentum, or sealing it if too indurated.
3) Draining subphrenic abscesses extraperitoneally by making incisions below the costal margin or through the 12th rib bed and inserting drains into the abscess cavity.
A C S0103 Perioperative Considerations For Anesthesiamedbookonline
This document discusses perioperative considerations for anesthesia. It notes advancements in modern surgical care and alterations in anesthetic management to maximize patient benefit. A preoperative evaluation is important to assess medical history and current medications. Certain medications may need to be adjusted or discontinued before surgery, such as MAOIs, oral anticoagulants, and some herbal supplements, to reduce risks of adverse reactions or bleeding complications during the procedure. The risks and options for anesthesia should be discussed with the patient.
A C S0105 Postoperative Management Of The Hospitalized Patientmedbookonline
This document discusses postoperative management of surgical patients. It describes the different levels of postoperative care including same-day surgery, the surgical floor, telemetry ward, and intensive care unit. Factors determining a patient's disposition include their preoperative health, procedure performed, and postoperative clinical status. The document also discusses common postoperative orders related to tubes, drains, oxygen therapy, and wound care to guide nursing staff.
Postoperative pain is a complex experience involving sensory, emotional, and mental components. Effective pain management is important for patient comfort and recovery. Guidelines for postoperative pain treatment have been developed for specific procedures. Multimodal analgesic regimens targeting multiple pathways are recommended over reliance on opioids alone to prevent tolerance and hyperalgesia. Nonpharmacological complementary therapies can be combined with drug treatments to enhance pain control.
The document discusses the approach to a patient experiencing ongoing bleeding. It outlines the following key steps:
1. First consider the possibility of a technical cause like an unligated vessel and examine for injuries.
2. If no technical cause is found, check the patient's temperature and perform laboratory tests. Hypothermia can cause coagulopathy.
3. Evaluate test results along with the patient's history for clues to underlying causes like platelet dysfunction, coagulation factor deficiencies, or inherited bleeding disorders. Treat the specific condition while continuing evaluation.
A C S0812 Brain Failure And Brain Deathmedbookonline
This document discusses brain failure and brain death. It defines different levels of impaired consciousness from cloudy consciousness to coma. It describes how brain failure results from cardiac arrest and the challenges of restarting the brain after lack of oxygen. It outlines the criteria for diagnosing brain death, including absence of brain stem reflexes and apnea testing. It also discusses the evolution of determining death as technology has allowed life support to prolong vital signs indefinitely.
This document summarizes key points about surgical treatment of early rectal cancer and care of elderly surgical patients. It discusses that radical resection for early rectal cancer achieves excellent local control but has risks, while local excision may be preferable but has a higher local recurrence rate. Adjuvant therapy after local excision may help address this. It also notes that the elderly population is growing and physiologic changes with aging, like cardiac function decline, must be considered in surgical planning and risk assessment for elderly patients. Functional status is more important than age alone.
This document provides information on parotidectomy surgery and the Fundamentals of Laparoscopic Surgery (FLS) program.
It describes the technique for parotidectomy surgery, including identifying and dissecting around the facial nerve. It notes that most parotid tumors are benign and complications are usually temporary facial nerve paralysis.
It then discusses the development of the FLS program to standardize laparoscopic surgery training. The program includes cognitive training and manual skills assessment. Many residency programs and hospitals now require surgeons to complete the FLS. A large grant will help make the program more accessible to residency programs.
This document summarizes an article about volunteer surgeons providing care to wounded soldiers in Iraq and Afghanistan. It discusses the senior visiting surgeon program established by the American College of Surgeons that allows surgeons to volunteer their time. The volunteer rotation described involved caring for patients at Landstuhl Regional Medical Center in Germany as part of the complex medical evacuation process bringing wounded soldiers from war zones to the United States for further treatment and recovery.
1. The document discusses various sources of data for benchmarking surgical outcomes, including public reporting programs, public use administrative databases, and clinical registries. It notes limitations of using administrative data including problems with accuracy, completeness, and clinical precision of coding.
2. Clinical registries like the National Surgical Quality Improvement Program (NSQIP) and the Society of Thoracic Surgeons database are described as better sources of benchmarking data as they provide risk-adjusted outcomes while protecting individual hospital and surgeon confidentiality.
3. Limitations of all surgical benchmarking sources include small sample sizes, lack of generalizability between databases, and lack of external auditing to ensure accuracy and completeness of submitted data.
This document discusses organ procurement from cadaveric donors. It describes the coordination between donor and recipient activities, including matching organs to recipients based on factors like blood type, medical urgency, and waiting time. The evaluation of donor organs is outlined for different organs. Careful donor management aims to optimize organs while respecting donor dignity.
Hand-assisted laparoscopic surgery (HALS) is a hybrid technique that provides many of the advantages of traditional open surgery and laparoscopic colectomy. HALS employs a special access device that allows the surgeon to place a hand in the abdomen to assist with retraction, dissection, and visualization while maintaining pneumoperitoneum and laparoscopic instrumentation through trocars. Studies have shown HALS results in shorter operative times and lower conversion rates to open surgery compared to traditional laparoscopic colectomy while preserving similar short-term clinical outcomes. HALS may help expand the use of minimally invasive approaches for complex colectomies by providing an easier transition from open surgery than traditional laparoscopic techniques.
The document summarizes the evolution of trauma surgery training and practice in the United States. It discusses how trauma surgery originated in large city hospitals but has since expanded to regional trauma centers. It also notes changes in surgical training away from generalist models towards increased specialization. Trauma surgery is increasingly encompassing broader emergency general surgery duties due to workforce shortages, while training programs emphasize specialized rather than broad skills.
This document provides reference values for many common clinical chemistry analytes measured in various specimens like plasma, serum, urine, and whole blood. The analytes include metabolic panels, lipids, proteins, electrolytes, vitamins, and more. Reference ranges are given in conventional and SI units for each analyte. The purpose is to provide clinicians with the normal expected ranges to interpret laboratory results at the Massachusetts General Hospital.